THE IMPACT OF ACTIVE LIFESTYLE ON FUNCTIONAL FITNESS LEVEL OF OLDER

WOMEN

A Thesis by

Samuel Ofei-Dodoo

Master of Public Administration, Wichita State University, 2010

Submitted to the Department of Public Health Sciences

and the faculty of the Graduate School of

Wichita State University

in partial fulfillment of

the requirements for the degree of

Master of Arts

July 2012

© Copyright 2012 by Samuel Ofei-Dodoo

All Rights Reserved

iii

THE IMPACT OF ACTIVE LIFESTYLE ON FUNCTIONAL FITNESS LEVEL OF OLDER

WOMEN

The following faculty members have examined the final copy of this thesis form and content, and

recommend that it be accepted in partial fulfillment of the requirement for the degree of Master

of Arts with a major in Aging Studies.

__________________________________

Nicole L. Rogers, Committee Chair

__________________________________

Suzanne Hawley, Committee Member

__________________________________

Michael E. Rogers, Committee Member

iv

DEDICATION

To my mother, Elizabeth Ampofo for her sacrifices over the years.

v

ACKNOWLEDGEMENTS

I owe a debt of gratitude to many people who have directly and indirectly contributed to

this project. I would like to express my sincere appreciation to Dr. Nicole L. Rogers for her

immense support and guidance during the entire time of the project. I wish to acknowledge Dr,

Amy Morgan, Sahar Amini, and Jenifer Gurnsey whose work has provided an example that have

been used in this paper. I also thank the committee members for their constructive criticisms,

and finally, I would like to thank Dr. Ed Flentje, Dr. Nancy McCarthy-Snyder, Dr. Melissa

Walker, Aanaiyah Saechao, Rachel Owens, and Joshua Allotey Snr. for their encouragement and

support. I am ever grateful to all.

vi

ABSTRACT

As adults reach advanced ages, the purpose of physical activity may shift from disease

prevention to functional fitness and mobility. The purpose of the study is to test the hypothesis

that engaging in an active lifestyle is associated with higher functional fitness in older women.

Functional fitness was assessed by the Senior Fitness Test in 125 women (73.42 ± 8.84 yrs).

Participants wore an accelerometer for 7 days without altering their normal activity.

Accelerometer data were downloaded, moderate and vigorous physical activity (MVPA)

determined via proprietary filtering, and time spent in each intensity was calculated. A 5 day

average of time spent in MVPA was organized into 4 groups. Frequency distributions were

calculated to examine the number of participants meeting ACSM recommendation for MVPA.

With respect to MVPA, only 18% of participants met ACSM recommendations by engaging in

30 minutes of moderate intensity physical activity for at least 5 days per week. Nearly half of

the participants were classified as normal on most functional measures.

To determine if a relationship existed between the participants 5 day MVPA, functional

fitness, age and weight, correlation coefficients were calculated. The strongest relationships

were found between MVPA and the 6 min walk (r = 0.52, p ≤ 0.001), chair stands (r = 0.46, p ≤

0.001), and up & go (r = -0.44, p ≤ 0.001). To determine if engaging in an active lifestyle is

associated with higher functional fitness, participants were grouped by time spent in moderate

intensity physical activity to determine a cut-off on improvement observed in functional fitness.

MVPA group comparisons were made using one-way ANOVAs with follow-up Post Hoc

analysis. The results revealed significant differences between groups on all measures except sit

and reach. The one-way ANOVA indicated a threshold of 20 minutes for the 6 min walk, chair

stand, and up & go. With regard to upper body strength and flexibility, less than 10 min of

MVPA was observed to be detrimental to performance.

vii

TABLE OF CONTENTS

Chapter Page

1. INTRODUCTION ...............................................................................................................1

1.1 Purpose ....................................................................................................................2

1.2 Statement of the Problem .........................................................................................3

1.3 Significance of the Study ........................................................................................3

1.4 Definitions ...............................................................................................................4

1.5 Variables .................................................................................................................7

1.6 Assumptions .............................................................................................................7

1.7 Limitations ..............................................................................................................7

1.8 Delimitation ............................................................................................................8

2. LITERATURE REVIEW ....................................................................................................9

2.1 Physical Activity and Health ..................................................................................9

2.2 Physical Activity and Functional Fitness ..............................................................15

3. METHODOLOGY ............................................................................................................19

3.1 Study Population and Screening ...........................................................................19

3.2 Procedure ...............................................................................................................19

3.3 Assessment .............................................................................................................20

3.4 Data Groups ...........................................................................................................24

3.5 Data Analysis .........................................................................................................24

4. RESULTS ..........................................................................................................................26

4.1 Normality and Assumptions .................................................................................26

4.2 Participants Characteristics ...................................................................................26

4.3 Relationship between MVPA and Functional Fitness ..........................................29

4.4 Moderate Intensity Cut-Off Points.........................................................................31

5. DISCUSSION ....................................................................................................................35

5.1 Conclusion ............................................................................................................38

5.2 Future studies .........................................................................................................39

BIBLIOGRAPHY ..........................................................................................................................40

viii

TABLE OF CONTENTS (Continued)

Chapter Page

APPENDICES ...............................................................................................................................46

A. Informed Consent Document........................................................................................47

B. Exercise and Screening for You ...................................................................................50

C. Medical Clearance Form ...............................................................................................51

D. Demographic Questionnaire Document .......................................................................53

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LIST OF TABLES

Table Page

3.1 5 day average of time spent in moderate intensity physical activity by group ..................24

4.1 Functional fitness classification .........................................................................................27

4.2 Correlation coefficients ......................................................................................................30

4.3 Moderate intensity cut-off points .......................................................................................32

x

LIST OF FIGURES

Figure Page

4.1 Functional fitness classification .........................................................................................28

4.2 Moderate intensity cut-cuff points: 6 minutes walk ..........................................................32

4.3 Moderate intensity cut-cuff points: chair stands ................................................................33

4.4 Moderate intensity cut-off points: up & go ........................................................................33

4.5 Moderate intensity cut-cuff points: arm curl .....................................................................34

4.6 Moderate intensity cut-off points: back scratch .................................................................34

1

CHAPTER 1

INTRODUCTION

The older population is growing very fast and the United Nations (2003) have estimated

that the number of older people aged 60 and older throughout the world would reach over 1.9

billion by 2050. This observation is not different in the United States. The older population has

been found to be the fastest growing age group in the United States, yet the least active group

(HHS, 2008). The American College of Sports Medicine (ACSM) recommends that regular,

moderate intensity physical activity is key to good health (Nelson, Rejeski, Blair, Duncan, Judge,

King, et al., 2007). The Centers for Disease Control and Prevention (CDC) and the American

Heart Association agree with ACSM’s recommendations that to maintain good health adults

should spend a minimum of 30 minutes, 5 days/week doing moderate intensity physical activity

or 20 minutes engaging in vigorous-intensity activity for at least 3 days/week.

Other studies have also shown that physical condition (balance, walking speed and lower-

extremity strength) is important to the health and functional fitness in old age (Yamauchi, Islam,

Koizumi, Rogers, Rogers, & Takeshima, 2005; Rogers, Sherwood, Rogers, and Bohlken, 2002;

Morgan, Tabor, and Snyder, 2010). Functional fitness predicts the likelihood of older adults

developing disease, disability, hospitalization, and mortality (Aoyagi, Park, Watanabe, Park, &

Shephard, 2009). Maintaining this function also helps older adults stay independently in their

home (Rikli and Jones 1999a).

Physical unhealthiness can lead to further health complications such as cancer, obesity,

cardiovascular disease, and ultimately decreased longevity (Woolf, Reese, Mason, Beaird,

Tudor-Locke, & Vaughan 2009). Moreover, Aoyagi & Roy (2009) have documented that there

2

is a positive association existing between habitual daily physical activity and functional fitness.

The 2008 Physical Activity Guidelines Advisory Committee Report states that, in addition to

health benefits associated with regular physical activity for older adults, there is a strong

relationship between physical activity and higher levels of functional fitness, lower risk of

falling, and even better cognitive ability. In spite of the benefits of maintaining an active

lifestyle, many older adults are inactive. The CDC reports that in 2005, only 49.1% of U.S

adults met the ACSM/CDC physical activity recommendation (Haskell, Lee, Pate, Powell, Blair,

et al. (2007). With this, the report shows that 50.7% men as compared to 47.9% women met

their recommendation; indicating that men are more likely to meet the ACSM/CDC physical

activity recommendation.

Data from 2005 showed that compared to older people, younger people are more likely to

be active. The prevalence of those meeting the recommendation declined by 20.6% (59.6%

among 18-24 year olds and 39.0% among people in 65 years and older). The Department of

Health and Human Services (2005) reports that only 25% of women 65-74 years participate in

regular physical activities and only 14% of women 75 years and older engage in any physical

activity; engaging in “no leisure time, household, or transportation physical activity” (CDC,

2001).

1.1 Purpose

Therefore, the purpose of the current study was to test the hypothesis that engaging in an

active lifestyle (amount and intensity) is associated with higher functional fitness in older

women. Frequency distributions were calculated to examine the number of participants meeting

ACSM recommendation for moderate and vigorous physical activity (MVPA) as well as the

3

number of participants with normal functional fitness as determined by the Rikli and Jones

classification. The relationship between time spent in moderate intensity physical activity and

functional fitness was examined. Participants were also grouped by their time spent in moderate

intensity physical activity to determine a cut-off on improvement observed in functional fitness.

1.2 Statement of the Problem

As adults advance in age, “their chronic disease is well established” and the purpose of

physical activity may center more on their functional fitness (a concept reflecting an older adult’s

ability to perform the physical activities of daily life with relative ease – requires strength,

balance, cardio, and flexibility). Active lifestyle is critical in delaying the onset of functional

limitations, maintaining independence, and improving quality of life. The findings of the study

will be an evidence-based guideline that will advance the strength of other studies that purport

the importance of older women engaging in active lifestyle to stay functional active and

independent.

1.3 Significance of the Study

It has been established that engaging in regular moderate intensity physical activity helps

maintain and promote health (Nelson, et al., 2007). Engaging in this type of activity also helps

older adults improve and/or maintain their physical fitness and functional independence, but not

all older adults engage in the recommended 30 minutes of moderate or 20 minutes of vigorous

exercise. The ability for older adults to live independently in their own home is to a large extent

dependent on their functional fitness, which is a reflection of their ability to perform their

everyday activity with ease. For older adults to perform their everyday activity (personal care,

4

housework, shopping), according to Rikli and Jones (1999a), is dependent on their capabilities to

engage in functional movements such as walking, stair climbing, standing, etc., which in turn

depends on having enough energy to perform those tasks without undue fatigue. So the study

will help older adults to understand that if they are not able to meet the recommended exercise

regimen, they could engage in physical activities that may be less than what is recommended and

still be functionally active. Generally, this study will improve the knowledge concerning the

potential of active lifestyle to improve the functional fitness of older individuals, thus, enhancing

the ability to help older adults to live independently in their homes and community for longer

periods of time. In addition, the study will contribute to our understanding of the relationships

between active lifestyle and functional fitness in older adults.

1.4 Definitions

1. Active lifestyle: Lifestyle activities that positively contribute to the improvement of

physical, mental, and social well-being of people. This includes regular exercise and

physical activities. According to Haskell et al. (2007), life activities like brisk walking,

gardening with the shovel, carpentry conducted in bouts of 10 minutes have been found

to be part of physical activity recommendations presented by ACSM/CDC. To maintain

an active lifestyle, it is important that people engage in physical activity and the simplest

and least expensive form is walking. For those who do not enjoy walking could engage

in other activities like swimming, dancing, or bicycling. Since walking has been found to

be the most prevalent and preferred physical activity mode (Williams, Matthews, Rutt, et

al., 2008), and the easiest way to measure active lifestyle, walking will be used to assess

the active lifestyle of the study participants. Behavioral Risk Factor Surveillance by

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Simpson, Serdula, Galuska, et al. (2003) estimates that between 1987 and 2000, about

30% of U. S men and 47% of U.S women reported walking in their leisure time with

over half of U.S adults reported engaging in walking 3 days/week for at least 30 minutes.

2. Physical Activity: Physical Activities: Any body movement that is produced by the

skeletal muscles, requires energy, and results in energy expenditure (Caspersen, Powell,

and Christenson, 1985). Walking, dancing, swimming, running, gardening, yoga, etc.

have all been cited by the U. S. Department of Human Services as some of the examples

of physical activity. The 2008 Physical Activity Guidelines for Americans, the HHS refers

physical activity as any “movement that enhances health.”

3. Exercise: Exercise: Exercise is often used in synonymous with physical activity because

they require skeletal muscle movements and energy expenditure. However, exercise has

been reported to be a sub-category of physical activity that is structured, planned, and

requires repetition with the aim of either improving or maintaining physical fitness

(Caspersen, Powell, and Christenson, 1985). Weight lifting, power skipping, rocket

jump, lateral bound, pushups, etc. are examples of exercise. Occupational and household

tasks/activities that are planned and structured with consecutive energy expenditure and

little or no regard to physical fitness are documented not to be exercise. However, those

activities that are performed in a labor producing manner, aim at producing muscle

strength, and “burn up” calories are considered exercise (Caspersen, Powell, and

Christenson, 1985).

4. ACSM Recommendations: In an attempt to provide a clear public health message and to

encourage healthy U.S adults between 18 and 65 years to maintain and promote health,

the ACSM/CDC issued a public health recommendation that these adults need to

6

accumulate at least 30 min moderate-intensity aerobic physical activity 5 days/week or

vigorous-intensity aerobic physical activity for 20 min 3 days/week (Haskell et al., 2007).

Combination of both the moderate-intensity aerobic activities and vigorous-intensity

could be used to achieve the recommendation. According to Haskell et al. (2007), to

achieve the recommendation, a person can engage in 30 min brisk walking for two days

and 20 min jogging for two days. The 30 min brisk walking could be achieved in a bout

lasting for 10 min or more.

5. Moderate Intensity Physical Activity: Generally equivalent to brisk walking, dancing,

gardening, housework and domestic chores, etc. that require moderate amount of effort

and “noticeably accelerate the heart rate” (Haskell, 2007). This is also calculated as

50%-70% of maximum heart rate.

6. Accelerometer: Kenz Lifecorder accelerometers (ACCEL) (Suzuken Company, Nagoya,

Japan) were used to assess the active lifestyle levels of the participants. The ACCEL

records physical activity intensities in ten different levels - zero to nine, with higher

numbers indicating higher intensity. The intensity levels are determined via a proprietary

filtering process that considers frequency and magnitude of accelerations. Previously

developed and validated formulas were used to calculate time spent in each intensity: 0 =

non-ambulatory, 1-3 = light, 4-6 = moderate and 7-9 = vigorous. The ACCEL is uniaxial,

small in size (62.5 mm

lithium battery (CR2032, 3V). According to the device, acceleration is sampled every

four seconds and recorded at two minute intervals (Crouter, et al., 2003).

The daily activity summary files of each participant were downloaded to an Excel

spreadsheet to determine physical activity intensities. Time spent in each intensity

7

(sedentary, low, moderate, vigorous) was calculated. A 5 day average of time spent in

MVPA was organized into 4 groups.

7. Functional Fitness: Functional fitness is a concept that reflects an older adult’s ability to

perform physical activities of daily life with relative ease (Rikli and Jones, 1990a). This

concept accounts for traditional physical fitness parameters such as muscle strength,

cardio-respiratory endurance, and flexibility, and also includes balance. Even in healthy

adults, each component of functional fitness declines with advancing age, negatively

affecting quality of life (Donato, Tench, Glueck, Seals, Eskurza, et al. (2003).

1.5 Variables

This project was a quasi-experimental study aimed at determining the effect of active

lifestyle on the functional fitness levels of older women. Depending on the grouping being

evaluated, accelerometer data and functional fitness will serve as an independent and dependent

variable.

1.6 Assumptions

It was assumed that the participants would wear the accelerometer during all waking

hours of the research period.

1.7 Limitations

The results of the study could have been affected by the following limitations: The

accelerometers do not provide objective measure of all forms of active lifestyle; thus, are not

capable of recording some lifestyle activities like swimming, bicycling, weight-training, yoga,

8

gardening with shovel, dancing (Tudor-Locke, Hart, & Washington, 2009; Haskell, Lee, Pate,

Powell, Blair, et al. (2007), and this could affect the accuracy of participant’s total daily

activities. Secondly, environmental factors (such as humidity, precipitation, and day length,

duration of bright sunshine and the mean ambient temperature) could affect results. For

example, the time spent in engaging in physical activity/active lifestyle is likely to decrease with

increasing precipitation.

1.8. Delimitations

The results of the study apply to older women, aged 55 to 95 years living in urban cities.

9

CHAPTER 2

LITERATURE REVIEW

2.1 Physical Activity and Health

Physical activity is associated with positive physical and mental health (Buchman, Boyle,

Yu, Shah, Wilson, et al., 2012; Yaffe, Nevitt, Lui, and Covinsky, 2001). A vast amount of

research supports the hypothesis that regular physical activity improves health and function, and

contributes to the prevention or delay of disability and disease. Despite this evidence, most

Americans are not sufficiently physically active (CDC, 2003). “Getting people to adopt and then

maintain a regular physical activity program are two of the biggest challenges facing public

heath in developed nations, including the United States” (Dishman, Washburn, and Heath, 2004).

Unfortunately, more than one-half of US adults do not meet the public health recommendations

for physical activity and those over the age of 50 years are least activity (34%) (CDC, 2003).

The efficacy of exercise for older adults is evidenced in a multitude of epidemiological

and clinical studies. Longitudinal studies have confirmed the cross-sectional studies that link

exercise to reduced risk of disease and disability. Most notably, researchers have demonstrated a

relatively immediate benefit of lifestyle changes, such as exercise, even among elderly and high-

risk persons (Fiatarone-Singh, M. A. (2001). According to Fiatarone-Singh (2001), exercise is

beneficial for the following diseases and syndromes: arthritis, cancer (breast, colon, prostate),

chronic renal failure, congestive heart failure, coronary artery disease, depression, frailty and

disability, gout, impotence, insomnia, impairment mobility and falls, osteoporosis and

osteoporotic fracture, stroke, type 2 diabetes mellitus, and urinary stress incontinence. Postulated

mechanisms of the exercise effect include decreased blood pressure, decreased body weight,

10

decreased LDL cholesterol, increased HDL cholesterol, decreased insulin resistance, decreased

cortisol levels, decreased depression, decreased anxiety, improved sleep, increased self-esteem,

increased body mass, increased muscle mass and strength, increased self-efficacy, maintenance

of cartilage integrity, improved body balance and gait stability, and others. After reviewing the

multitude of benefits that regular physical activity provides, the American College of Sports

Medicine (ACSM, 1998) has recommended that older adults engage in a well-rounded exercise

program consisting of aerobic, stretching, strength, and balance exercises.

Franco, de Laet, Peeters, Jonker, Mackenbach, et al. (2005) used data from the

Framingham Heart Study to determine the effects of physical activity on the life expectancy with

cardiovascular disease among people over 50 years. The authors used 4121 participants for the

current study where participants were grouped, based on tertiles of physical activity score, into

low (<30), moderate (30-33), and high (>33) physical activity levels. The authors used hazard

ratio for 3 transitions (healthy to death, healthy to disease, and disease to death) compared with

physical activity to perform life table calculations adjusting for age, sex, smoking, and

comorbidity. The results indicated that physical activity (moderate and high) prevents

cardiovascular disease as well as expanding life expectancy in both men and women. Compared

with men over 50 years who engaged in low physical activity, participants who engaged in high

and moderate physical activity lived 3.2 and 1.1 years more without cardiovascular disease,

respectively. Those who engaged in high and moderate physical activity lived 3.7 and 1.3 years

more than those men 50+ years who engaged in low physical activity, respectively. The results

on women were not different. Compared to those who engaged in low physical activity, the

women participants who engaged in high and moderate physical activities lived 3.3 and 1.3

11

cardiovascular free years, respectively. They lived 3.5 and 1.5 more when they engaged in high

and moderate physical activity, respectively.

To determine the effects physical activity has on heart rate variability, Rennie,

Hemingway, Kumari, Malik, and Marmot, (2003) conducted a Whitehall II Study using 3,328

participants (994 women and 2,334 men) aged 45 – 68 years, between 1997 and 1999. All the

study participants were nonindustrial civil servants working in London, United Kingdom. Each

participant filled out questionnaire that was prepared based on validated Minnesota leisure-time

activity questionnaire (Taylor, Jacobs Jr., Schucker, et al., 1978) indicating the kind and amount

of activity they engaged in as well as the time spent engaging in the activity. The numbers were

averaged to calculate the total hours each participant spent engaging in physical activity. The

authors used Ainsworth, Haskell, Leon, et al. (1993)’s compendium of activity energy costs to

assign metabolic equivalent values, which indicated the intensity of the activity. Heart rate

variability of each participant was also measured using the European Society of

Cardiology/North American Society of Pacing and Electrophysiology Task Force. After

adjusting for smoking, and high alcohol consumption, the findings indicate that, among other

things, physical activity (both vigorous and moderate) is associated with higher heart rate

variability levels, suggesting the possibility that physical activity reduces the risk of heart

diseases.

One article of interest was an elegant study involving 5,925 community-dwelling white

women aged 65 and older where Yaffe, Nevitt, Lui, and Covinsky (2001) tried to determine the

relationship between physical activity and cognitive impairments. The participants’ cognitive

performance was measured using a “modified Mini Mental State Examination”, which indicated

that most participants did not have cognitive impairment or physical limitations at baseline. Six

12

to eight years after the baseline measurement, the participants’ physical activity was measured by

“self-reported blocks (1 block = 160 m) walked per week and by total kilocalories (energy)

expended per week in recreation, blocks walked, and stairs climbed” (p. 1703).

The findings of the study indicated an association between physical activity and reduced

chance of older adults developing cognitive difficulties/impairments among the participants.

Whether it was measured as blocks walked per week or as a total kilocalories expended per

week, over the 6- to 8-year follow-up, community-dwelling women who had greater baseline

physical activity were less likely to develop cognitive decline. The findings support other

studies that have shown that physical activities prevent cognitive decline among older adults

(Christensen et. al., 1996 and Emery el. al., 1998).

In a prospective study of 2,257 physically capable men aged 71 to 91 year, Abbott,

White, Ross, Masaki, Curb, and Petrovitch (2004) evaluated the relationship between walking

and older adults’ future risk of developing dementia. Initial walking distance of the participants

was assessed from 1991 to 1993, and follow-up of incident of dementia was performed from

1994-1996 and 1997-1999 using neurological assessment. The findings of the study showed that

active lifestyle (walking) is associated with a reduced risk of dementia among men in this cohort.

This means that encouraging physically capable older adult men to engage in physical activity or

active lifestyle could help with their late-life cognitive function. Statistically significant,

although not substantial, these study findings also indicated that men who walked long distances

have reduced prevalence of diabetes and reduced risk of coronary heart disease. Participants

who walked less than 0.25 mile within a day had a 1.8-fold risk of experiencing total dementia

than those who walked more than 2 miles a day. The incidence of experiencing total dementia

among older men was reduced with an increase in the distance they walked.

13

A study by Morgan, Tabor, & Snyder (2010) was aimed to determine if there are positive

health, fitness, and psychological benefits when older individuals engage in an accumulated

10,000 steps/day. In spite of many studies that have shown that individual’s general well-being

improves when they engage in recommended 30 minutes/day physical activities for most days of

the week, many older adults, aged 55 years and older do not participate in physical activities on

most days of the week. Other studies have also shown that many chronic health conditions could

be “prevented entirely, managed, or improved” (p.307) through physical activities, yet many

older adults have been inactive and their inactiveness could be attributed to chronic conditions.

After 15-weeks of intervention, the results indicate that although not all functional fitness

improvements were statistically significant, there were improvements and they were both

physical and psychological benefits. There was a decrease in the total cholesterol level, and a

decrease in post-exercise heart rate, which was observed as a health benefit. In addition,

participants in the study group exhibited improved psychological well-being in addition to

exhibiting an increase in personal growth after the study. Based on these findings, the authors

concluded that walking programs are a means to increase physical activity of older adults aged

50 to 70. They (walking programs) are also a means to improve the “levels of health, fitness,

and well-being” (p.307) of older adults.

Chronic illnesses such as osteoarthritis, hypertension, diabetes, and peripheral vascular

diseases have been found to be common among frail older adults. Even though exercise has

been found to have nonpharmacologic benefits to this population, Heath & Stuart (2002) report

that the prescription of physical activity has been an underused therapy for frail older adults.

The authors believe this is due to barriers, which are created by the older adult themselves, their

caregivers, and their heath care providers.

14

To demonstrate that primary care providers can overcome these barriers by prescribing

strategic, safe and sustainable exercise programs that are geared towards the functional needs and

preference of the elderly, Heath & Stuart (2002) looked to the literature for support. The authors

argued that traditional elements such as “mode of exercise, intensity of exercise, and frequency

of exercise” (p.223) should be considered when prescribing exercise regimen to frail elderly.

Prescription of the appropriate element of training/exercise to the frail elderly should depend on

the “preserved functional skills, available resources, and perhaps most importantly, those forms

of exercise that offer the most enjoyment and can be sustained” (p. 223). Including balancing

and flexibility the mode of exercise was also found to prevent falls.

After a thorough review of the literature, the authors concluded that despite the existence

of the barriers, primary physicians are encouraged to promote exercise as a therapeutic

intervention to improve the functional fitness and overall health of frail elderly. The authors

encouraged physicians to be enthused about prescribing regular exercise to their frail patients.

Also, involving the frail elderly in the decision making process on the type of exercise that is

best for them, is essential in getting to commit to the program. The benefits associated with

incorporating exercise regimen in the treatment of the elderly do not only benefit them, but also

the society in general.

A recent study has found that active lifestyle, including simple household chores (like

dish washing, cooking, playing cards, etc.), could slow down older adults' cognitive decline and

reduce their risks of developing Alzheimer's disease, even among those who over 80 years old.

A prospective, observational cohort study by Buchman, Boyle, Yu, Shah, Wilson, et al. (2012)

evaluated 716 older adults whose 2 or more annual cognitive assessment showed no presence of

dementia. Each of the participants was issued a wrist Actigraphs, which recorded their

15

movement for 24 hours each day for up to 10 days. The Actigraph was capable of continuously

recording all activities (exercise and nonexercise physical activity) of the participants for up to

10 days. After structured annual clinical assessment and 19 cognitive tests, the study showed

very interesting results.

The results indicated that engaging in a relative active lifestyle reduces the rate of older

adults' cognitive decline and risk of developing Alzheimer's disease. Less than 10% (71) of the

participants developed Alzheimer's disease during the study. In addition, the results showed an

association between activity intensity levels and cognitive decline. Compared to the participants

who engaged in the most intense activity, those who engaged in least amount of activity were

almost 3 times likely to experience cognitive decline and develop Alzheimer's disease.

After reviewing the multitude of benefits that regular physical activity provides, the

American College of Sports Medicine (ACSM) has recommended older adults engage in a well-

rounded exercise program consisting of aerobic, stretching, strength, and balance exercises. It is

important to note that these four parameters not only yield substantial health and fitness benefits,

these activities also contribute to functional fitness.

2.2 Physical Activity and Functional fitness

In addition to the health benefits of active lifestyle, engaging in an active lifestyle also

improves the functional fitness of older adults. Several studies have established the amount (a

minimum of 30 min, 5 d/wk doing moderate intensity physical activity or 20 minutes engaging in

vigorous-intensity activity at least 3 days/week) of physical activity needed to improve the

overall health of older adults. Unfortunately, the amount of activity necessary to maintain

functional fitness is not yet established, and may be less than amounts necessary for good health.

16

Functional fitness is a concept that reflects an older adult’s ability to perform physical

activities of daily life with relative ease (Rikli and Jones, 1990a). As noted, this concept

accounts for traditional physical fitness parameters such as muscle strength, cardio-respiratory

endurance, and flexibility, and also includes balance. Even in healthy adults, each component of

functional fitness declines with advancing age, negatively affecting quality of life (Donato et al.

(2003). For example, the age-associated decline in muscle strength is a major cause of physical

disability in older people (Doherty, 2003) and decreased muscular strength and poor balance are

major risk factors for falls (Rogers and Evans, 1993). Furthermore, impaired joint flexibility can

negatively affect the ability to perform self-care activities such as bathing and dressing. Much

attention has been focused on regular physical activity as a means to enhance health and

maintain function in old age and several exercise programs have been designed to improve the

parameters of fitness and, in turn, enhance function (ACSM, 1998; 1998a).

Aerobic exercises. It is established that aerobic exercises such as walking and running

improve cardiorespiratory endurance in older adults with walking eliciting impact forces that are

3.6 times less than running (Torama, Erman, and Agyar, 2004), resulting in low bone-joint stress

(Moreland, Richardson, Chan, O’Neill, Bellissimo, et al. (2003). Considering the orthopedic and

other medical factors associated with aging, walking is an often prescribed exercise mode for

older people to promote cardiorespiratory fitness (Voloshin, 1988) and, indeed, walking has been

reported to be the most common physical activity reported by adults in the United States,

Canada, and Europe (DiPietro, 2001).

Strength Exercises. Sarcopenia (loss of muscle mass) in aging is also well documented.

Musculoskeletal weakness and disability is especially common among older women and, along

with compromised flexibility and balance, contributes to functional disability and the risk of

17

falls. Strength training can result in improvements in muscle size and strength in elderly men

and women; and can also improve balance and gait speed in very old and frail nursing home

residents, improve bone health, and decrease many of the risk factors for an osteoporotic fracture

(Drewnowski and Evans (2001).

Balance Exercises. In many cases, poor postural balance is a primary risk factor for falls

(Miotto, Chodzko-Zajko, Reich, and Supler, 1999; Takeshima, Tanaka, Kobayashi, Sumi,

Watanabe, et al., 1993). Although sometimes difficult to define and measure, postural balance is

basically the ability to maintain the body’s position over its base of support, whether the base is

stationary or moving (Rogers, Sherwood, Roger and Bohlken (2002). Fortunately, research

indicates balance exercise programs can improve postural balance (Borg, 1982; Hunter,

Wetzstein, McLafferty Jr., Zuckerman, Landers, et al. (2001) in older adults.

A cross-sectional study by Brach, Simonsick, Kritchevsky, Yaffe, and Newman (2004)

used 3,075 well-functioning older adults between the ages of 70 and 79 years old in the study,

which was to determine the effects of normal physical activities on older adults’ functional

fitness. The researchers used “modified leisure-time physical activity questionnaire” to group

the participants into inactive, lifestyle active and exercise groups and the Established

Populations for the Epidemiologic Studies of the Elderly (EPESE) battery was used to measure

the subjects’ functional fitness levels.

The results of the study indicate that engaging in even small amounts of physical activity

helps slow the decline in functional fitness, older adults who engage in 20-30 minutes of

moderate intensity exercise on regular basis, most of the days in a week, exhibit better health and

have better functional compared to those who are less active throughout the day or those who are

inactive. That is, although lifestyle activities may reduce older adults’ chance of experiencing

18

functional limitations, greater functional capacity is seen in older adults who engage in physical

exercise. The findings of the study also indicated that both the amount and intensity of the

physical activity older adults engage in are important in making them functionally fit as well as

bettering their health outcomes.

Aoyagi, Park, Watanabe, Park, and Shephard (2009) conducted a study of 170 Japanese

participants aged 65 to 84 years, to determine the association between functional fitness and a

year of accelerometer determined physical activity. The average steps/day and the duration of

moderate intensity physical activity were the variables of this study. The researchers used

“preferred and maximal walking speeds, peak handgrip force, peak knee extension torque, total

body sway and maximal functional reach” to measure the functional fitness of older adults.

After a year of wearing the accelerometors, results indicate a significant positive relationship

between daily steps and the duration of moderate intensity activities as well as the lower body

functions of knee extension torque and walking speed.

Purath, Buchholz & Kark (2009) studied the relationship between functional fitness,

demographic characteristics, physical activity and health using 34 participants aged 60 years and

older in a community setting. The functional fitness of the participants was measured using the

validated Senior Fitness Test (SFT) protocol. The participants were asked to complete a self-

report of their demographics, general health and also the level of their physical activity during a

period of one week. The results of the study revealed that older adults who reported fewer

chronic conditions and better health condition had better score on the SFT measures. Also, the

participants who reported to engage in more physical activity “had significantly better upper and

lower body strength, aerobic endurance, and dynamic balance” Purath et al. (2009).

19

CHAPTER 3

METHODOLOGY

3.1 Study Population and Screening

A total of one hundred and twenty five older women between the ages of 55 and 95 years

old (73.42 ± 8.84 yrs) were recruited from two mid-western communities. The Wichita State

University Institutional Review Board approved the study protocol, and each participant read and

signed an informed consent document (Appendix A). Each participant was screened with the

EASY (Exercise and Screening for You) questionnaire (Appendix B). Physician’s permission

was requested from participants whose EASY results showed they were not fit to participate in

the study (Appendix C). Participants whose physical and mental health prevented them from

properly participating in the study were excluded from the study.

3.2 Procedure

After the screening process, each participant met with study investigators to complete a

functional fitness assessment and then wore a locked accelerometer for 2 weeks during all

walking hours. Participants were instructed to take off the accelerometer to bathe or swim. The

accelerometer was worn at waist, clipped to a belt or clothing, and centered over the dominant

foot. Prior to accelerometer distribution, each participant’s functional fitness was measured

using the Rikli & Jones (1999a) Functional Fitness Assessment, a validated senior fitness test

protocol. The assessments were conducted using individual stations and participants were asked

to go from one station to another, in an orderly manner, where they were assessed. During the

walking test, participants walked in small groups, and each participant’s performance was

20

measured after the group walk was complete. Following the functional fitness assessment

accelerometers were distributed to participants with instructions to return it in two weeks.

3.3 Assessment

I. Demographics

Each participant answered demographic questionnaire that asked about variables such as

current age, ethnicity, marital status, education background, and household income.

There was also self-reports of alcohol consumption, smoking status, personal history of

disease, and medication use (Appendix D).

II. Active lifestyle assessment

Kenz Lifecorder accelerometers (ACCEL) (Suzuken Company, Nagoya, Japan) were

used to assess the active lifestyle levels of the participants. The ACCEL records physical

activity intensities in ten different levels - zero to nine, with higher numbers indicating

higher intensity. The intensity levels are determined via a proprietary filtering process

that considers frequency and magnitude of accelerations. Previously developed and

validated formulas were used to calculate time spent in each intensity: 0 = non-

ambulatory, 1-3 = light, 4-6 = moderate and 7-9 = vigorous. The ACCEL is uniaxial,

lithium battery (CR2032, 3V). According to the device, acceleration is sampled every

four seconds and recorded at two minute intervals (Crouter, et al., 2003).

The daily activity summary files of each participant were downloaded to an Excel

spreadsheet to determine physical activity intensities. Time spent in each intensity

21

(sedentary, low, moderate, vigorous) was calculated. A 5 day average of time spent in

MVPA was organized into 4 groups.

III. Functional fitness assessment

The Rikli & Jones (1999a) validated Functional Fitness test protocol was used to assess

the functional fitness performance of the participants: 30-sec Chair Stand, 30-sec Arm

Curl, Chair Sit and Reach, Scratch Test, 8’ Up and Go, and 6-Minute Walk.

1. 30-Second Chair Stand: The purpose of this assessment was to measure lower body

strength. The test began with the participant seated in the middle of the chair, back

straight, and feet approximately shoulder width apart and flat on the floor. Arms were

crossed and held against the chest. At the signal "go" the participant rose to a full

stand (body erect and straight) and then returned back to the initial seated position.

The participant was encouraged to complete as many full stands as possible within a

30-second time limit. Participants were given two or three practice repetitions. The

score was the total number of stands executed correctly within 30 seconds. If the

participant was more than halfway up upon completion of the 30 seconds, it counted

as a full stand.

2. 30-Second Arm Curl: The purpose of this assessment was to measure upper body

strength. The participant was seated on a chair, back straight and feet flat on the

floor, and with the dominant side of the body close to the edge. The weight was held

at the side in the dominant hand. The test began with the arm in the down position

beside the chair, perpendicular to the floor. At the signal "go" the participant curled

the arm through a full range of motion, and then returned to the fully extended

position in a controlled manner. The participant repeated this movement as many

22

times and as quickly as possible in 30-seconds. The score was the total number of

curls made correctly within 30 seconds. If the participant's arm was more than

halfway up at the end of 30 seconds, then it counted as a completed curl. A 5-lb

dumbbell was used by the participants.

3. Chair Sit and Reach Test: The purpose of this assessment was to assess lower body

(primarily hamstring) flexibility. The test began with the participant sitting on the

front edge position of a chair. Keeping one leg bent and foot on the floor, the other

leg (the preferred leg*) was extended straight in front of the hip, with heel on the

floor and foot flexed. With the extended leg as straight as possible, the participant

slowly bent forward at the hip joint sliding the hands (one on top of the other with the

tips of the middle fingers even) down the extended leg in an attempt to touch the toes.

The reach was held for two seconds. A ruler was used to measure the number of

inches (nearest ½ inch) a person is short of reaching the toes (minus score) or reaches

beyond the toes (plus score). The participant was given two practice trials. The score

was the best measure of two trials. * The preferred leg is defined as the one that

results in the better score.

4. 8’ Up and Go: The purpose of this assessment was to measure physical mobility

involving speed, agility, and dynamic balance. The test began with the participant

fully seated in the chair, hands on thighs, and feet flat on the floor. The participant

was allowed to push off the sides or arms of the chair to aid in getting up from the

chair. On the signal “go”, each participant was instructed to stand up from the chair

as quickly as possible, walk around a cone placed 8 feet in front of the chair, and

return to a seated position in the chair. The participant was told the test was timed

23

and that the object was to walk around the cone as fast as possible (without running)

and return to a seated position. A timed score was recorded from moment the signal

“go” was given until the participant returned to a seated position on the chair. The

participant was allowed to walk through the test for practice. The participant's score

was recorded as the best of the two most consistent times measured.

5. Scratch Test: The purpose of this assessment was to assess upper body (shoulder)

flexibility. In a standing position, the participant placed the preferred hand* over the

same shoulder and reached as far as possible down the middle of the back, palm down

and fingers extended. Hand of other arm was placed behind back, palm up, reaching

up as far as possible in an attempt to touch (or overlap) the extended middle fingers of

both hands. The distance of overlap, or distance between the tips of the middle

fingers was measured to the nearest ½ inch. Minus scores (-) were given to represent

the distance short of touching middle fingers; plus scores (+) represent the degree of

overlap of middle fingers. The "best" score was used to evaluate performance. *The

preferred hand is defined as the one that results in the better score.

6. 12-Minute Walk: The purpose of this test was to assess aerobic endurance. The test

involved assessing the maximum distance that can be walked in 12 minutes along a

50-meter course, marked into 5-meter segments. Participants continuously walked

around a measured lap throughout the 12-minute period, trying to cover as much

distance as possible. On the signal "go", participants were instructed to walk as fast

as possible (not run) the marked distance around the cones as many times as they can

within the time limit. If necessary, participants could stop and rest, sit on chairs

24

provided, then resume walking. The score was the total number of yards walked in

12 minutes to the nearest 5 meter indicator.

3.4 Data Groups

Time Spent in Moderate Intensity. To address the hypothesis that time spent in moderate

intensity physical activity will impact functional fitness measures, a 5 day average of time spent

in moderate intensity physical activity was organized into 4 groups: 0:00-9:59 min, 10:00-19:59

min, 20:00-29:59 min, and 30:00 plus min (In Table 3.1).

TABLE 3.1

5 DAY AVERAGE OF TIME SPENT IN MODERATE INTENSITY PHYSICAL ACTIVITY

BY GROUP

Group Name Group (min) n

10 min 0:00-9:59 58

20 min 10:00-19:59 27

30 min 20:00-29:59 14

30+ min 30:00+ 22

3.5 Data Analysis

Data analysis was completed using the statistical software program SPSS for Windows

V.16.0 (SPSS Inc., Chicago, IL). Data were expressed as mean ± SD and screened for outliers,

and the assumptions of normality and homoscedasticity. Assumptions of homogeneity of

variance and sphericity were evaluated. Frequency distributions were calculated to examine the

number of participants meeting ACSM recommendation for MVPA as well as the number of

participants with normal functional fitness as determined by the Rikli and Jones (1999a)

classification. Functional fitness scores were grouped based on Rikli and Jones (1999a)’s

25

validated Senior Fitness Test Normal Range Scores. The Senior Fitness Test evaluates older

adults’ functional fitness performance and the score is based on the participant’s age and the

number of time s/he is able to perform each activity (Chair Stands, Arm Curls, 6-Min Walk,

Chair Sit and Reach, Back Scratch, 8-Ft Up-&-Go). Those scoring below range are considered

below average for their age, those scoring within range are considered average for their age, and

those scoring above range are considered above average for their age. Correlations between 5

day MVPA averages and Senior Fitness Test measures (Chair Stands, Arm Curls, 6-Min Walk,

Chair Sit and Reach, Back Scratch, 8-Ft Up-&-Go) were calculated to determine the relationship

between time spent in MVPA and functional fitness. To determine cut-off points, moderate

intensity group comparisons were made using one-way ANOVA with follow-up post hoc

analysis. A probability value of less than 0.05 was considered statistically significant and a

Bonferroni adjustment was used to correct for multiple measurements.

26

CHAPTER 4

RESULTS

4.1 Normality and Assumptions

Non-significant Kolomogorov-Smirnov tests indicated all variables were normally

distributed. In addition, histograms and normal Q-Q plots revealed normal distributions of

variables in all groups. Assumptions of homogeneity of variance and sphericity were evaluated

and not violated.

4.2 Participant Characteristics

One hundred and twenty five women completed the assessments. Participants

characteristics are as follows: Age (73.42 ± 8.84 yrs), Height (63.22 ± 2.73 cm), Weight (159.17

± 33.32 lb), and Body Mass Index (28.64 ± 6.29). With respect to the number of participants

meeting ACSM recommendations, only 17.6% (22 of 125) of participants met this

recommendation. With respect to functional fitness, normal functional fitness classifications

were made using guidelines set by Rikli and Jones (1999a). Participants scoring higher or lower

than the Rikli and Jones normal classification were noted as below normal or above normal

(Table 4.1).

27

TABLE 4.1

FUNCTIONAL FITNESS CLASSIFICATION

Age Group BMI

Chair

Stands

Arm

Curls

6-Min

Walk

Sit-&-

Reach

Back

Scratch

Up-&-

Go

n % n % n % n % n % n % n %

55 - 65 years (n=24)

Below Normal 0 0% 4 17% 0 0% 6 25% 5 21% 14 58% 10 42%

Normal 7 29% 13 54% 8 33% 6 25% 11 46% 10 42% 7 29%

Above Normal 17 71% 7 29% 16 67% 11 46% 8 33% 0 0% 7 29%

65-69 years (n=25)

Below Normal 0 0% 4 16% 0 0% 7 28% 5 20% 12 48% 6 24%

Normal 7 28% 15 60% 8 32% 9 36% 16 64% 8 32% 13 52%

Above Normal 18 72% 6 24% 17 68% 8 32% 3 12% 5 20% 6 24%

70-74 years (n=27)

Below Normal 0 0% 4 15% 3 11% 3 11% 6 22% 12 44% 4 15%

Normal 4 15% 18 67% 11 41% 19 70% 16 59% 10 37% 15 56%

Above Normal 23 85% 5 19% 13 48% 5 19% 4 15% 5 19% 8 30%

75-79 years (n=22)

Below Normal 0 0% 2 9% 1 5% 5 23% 5 23% 13 59% 4 18%

Normal 12 55% 14 64% 12 55% 7 32% 11 50% 3 14% 9 41%

Above Normal 9 41% 5 23% 9 41% 10 45% 6 27% 6 27% 9 41%

80-84 years (n=16)

Below Normal 0 0% 3 19% 2 13% 3 19% 4 25% 5 31% 0 0%

Normal 7 44% 9 56% 4 25% 5 31% 11 69% 5 31% 9 56%

Above Normal 9 56% 4 25% 10 63% 7 44% 1 6% 6 38% 6 38%

85-89 years (n=8)

Below Normal 0 0% 3 38% 1 13% 3 38% 3 38% 7 88% 2 25%

Normal 2 25% 3 38% 5 63% 2 25% 4 50% 1 13% 6 75%

Above Normal 5 63% 1 13% 2 25% 2 25% 1 13% 0 0% 0 0%

90+ years (n=3)

Below Normal 0 0% 1 33% 0 0% 0 0% 0 0% 1 33% 0 0%

Normal 3 100% 1 33% 2 67% 3 100% 3 100% 2 67% 2 67%

Above Normal 0 0% 1 33% 1 33% 0 0% 0 0% 0 0% 1 33%

TOTAL (n=125)

Below Normal 0 0% 21 17% 7 6% 27 22% 28 23% 64 51% 26 21%

Normal 42 34% 73 59% 50 40% 51 42% 72 59% 39 31% 61 49%

Above Normal 81 66% 29 24% 68 54% 43 36% 23 19% 22 18% 37 30%

28

FIGURE 4.1 FUNCTIONAL FITNESS CLASSIFICATION

Functional fitness classification by age group is provided in Table 4.1. In general,

approximately half of the participants were classified as normal, with the exception of BMI

(34%) and back scratch (31%). Moreover, approximately ¼ of participants were classified as

below normal and ¼ were classified as above normal. BMI was an exception with 66% of

participants being above normal, as well as arm curls where participants performed above normal

(54%) compared to their age group, and back scratch in which participants upper extremity

flexibility was below normal (51%).

29

4.3 Relationship between MVPA and Functional Fitness

Pearson product moment correlations were used to determine if a relationship existed

between the participants 5 day MVPA, functional fitness, age and weight (Table 4.2). The

correlation coefficients indicated that all variables were significantly related to MVPA, although

the relationship was negligible for sit and reach (r = 0.19, p ≤ 0.05), and weak for back scratch (r

= 0.23, p ≤ 0.01), arm curl (r=0.23, p ≤ 0.01) and age (r = -0.28, p ≤ 0.001). The strongest

relationships were found between MVPA and the 6 min walk (r = 0.52, p ≤ 0.001), chair stands

(r = 0.46, p ≤ 0.001), and the up & go (r = -0.44, p ≤ 0.001). A moderate relationship was noted

between MVPA and BMI (r = -0.31, p ≤ 0.001) and weight (r = -0.30, p ≤ 0.001).

30

TABLE 4.2

CORRELATION COEFFICIENTS

** Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level (2-tailed).

MVPA Age Weight BMI Chair 6 Min Walk Up & Go Arm Curl Sit & Reach Back Scratch

MVPA Pearson Correlation

Sig. (2-tailed)

N

Age Pearson Correlation -.283 **

Sig. (2-tailed) .001

N 125

Wt Pearson Correlation -.304 ** -.340 **

Sig. (2-tailed) .001 .000

N 125 125

BMI Pearson Correlation -.306 ** -.232 * .786 **

Sig. (2-tailed) .001 .010 .000

N 122 122 122

Chair Pearson Correlation .464 ** -.413 ** -.187 * -.185 *

Sig. (2-tailed) .000 .000 .038 .043

N 123 123 123 120

6 Min Pearson Correlation .523 ** -.365 ** -.299 ** -.355 ** .541 **

Walk Sig. (2-tailed) .000 .000 .001 .000 .000

N 121 121 121 118 119

Up & Go Pearson Correlation -.436 ** .432 ** .178 * .168 -.623 ** -.641 **

Sig. (2-tailed) .000 .000 .047 .065 .000 .000

N 125 125 125 122 123 121

Curl Pearson Correlation .223 * -.368 ** .117 .076 .506 ** .459 ** -.538 **

Sig. (2-tailed) .012 .000 .194 .407 .000 .000 .000

N 125 125 125 122 123 121 125

Reach Pearson Correlation .191 * -.168 -.183 * -.277 ** .145 .232 * -.170 .088

Sig. (2-tailed) .034 .063 .042 .002 .112 .011 .060 .335

N 123 123 123 120 121 120 123 123

Scratch Pearson Correlation .227 * -.070 -.476 ** -.497 ** .197 * .397 ** -.483 ** .180 * .281 **

Sig. (2-tailed) .011 .439 .000 .000 .029 .000 .000 .045 .002

N 125 125 125 122 123 121 125 125 123

31

4.4 Moderate Intensity Cut-Off Points

To determine if engaging in an active lifestyle is associated with higher functional fitness

participants were grouped by their time spent in moderate intensity physical activity to determine

a cut-off on improvement observed in functional fitness. MVPA group comparisons were made

using one-way ANOVAs with follow-up Post Hoc analysis. The point at which no difference

occurred between MVPA groups indicated additional time spent in MVPA did not improve that

functional fitness measure. The same analysis was also conducted for weight and BMI.

The results revealed significant differences between groups on all measures except sit and

reach (Table 4.3). The one-way ANOVA indicated a threshold of 20 minutes for the 6 min walk

(F=16.72, p ≤ 0.001), chair stand (F=14.06, p ≤ 0.001), and up & go (F=13.36, p ≤ 0.001). For

all 3 lower body functional fitness measures, the follow-up post hoc revealed that the 10 minute

group was significantly different from all other groups (p ≤ 0.01). However, a cut-off was

observed for the 20 minute group. Although the 20 minute group was different from the 10

minute group, there was no difference between the 30 minute and 30+ minute groups, suggesting

that engaging in more than 19:59 minutes of MVPA yields no additional statistical gain on the 6

min walk, chair stand, and up & go. With regard to upper body strength and flexibility, less than

10 min of MVPA is detrimental to performance. The one-way ANOVA for arm curl (F=5.42, p

≤ 0.01) and back scratch (F=2.62, p ≤ 0.05) were significant. The follow-up post hocs revealed a

cut-off for the 10 minute group, in that the 10 minute group was different from all other groups

(20 minute, 30 minute and 30+ minute groups).

32

TABLE 4.3

MODERATE INTENSITY CUT-OFF POINTS

MVPA

(min) n

Average

Time (min)

Range 6 min

Walk (yd) Chair (#)

Up & Go

(s) Curl (#) Scratch (in)

0:00-9:59 58 3:42 0:02 – 9:58 462±137* 11±3.5* 7.05±2.24* 16.0±5.0 9.7±13.54

10:00-19:59 27 14:37 10:18 – 19:43 538±174* 14±3.0* 5.56±1.16* 20.0±6.0† 6.48±8.35†

20:00-29:59 14 24:39 20:06 – 27:52 607±95 15±4.0 5.41±1.19 20.0±6.5† 3.89±8.78†

30:00+ 22 48:38 31:24 – 2:17:07 687±90 16±4.5 4.52±0.95 20.5±4.0† 2.91±6.32†

* different from 20:00min (p < .05) † different from 0:00 min (p < .05)

FIGURE 4.2 MODERATE INTENSITY CUT-OFF POINTS: 6 MINUTES WALK

33

FIGURE 4.3 MODERATE INTENSITY CUT-OFF POINTS: CHAIR STANDS

FIGURE 4.4 MODERATE INTENSITY CUT-OFF POINTS: UP & GO

34

FIGURE 4.5 MODERATE INTENSITY CUT-OFF POINTS: ARM CURL

FIGURE 4.6 MODERATE INTENSITY CUT-OFF POINTS: BACK SCRATCH

35

CHAPTER 5

DISCUSSION

Individual lifestyle choices, not genetic inheritance, have been documented as the major

influence on successful aging; with physical active lifestyle being one of the contributory factors

to successful aging (CDC, 2001). Physical activity prevents many primary and secondary

chronic disease risk factors, chronic diseases, and disabling conditions that are associated with

older adults. It also delays both the onset of functional limitation and loss of independence

among older adults (CDC, 2001). Ferrucci et al. (2000) report that compared to inactive,

nonsmoking women aged 65; highly active, nonsmoking women 65 years have nearly 6 years

active life expectancy. The American Academy of Rheumatologists has recommended physical

activity in arthritis management. A study by Kovar et al. (1992) reported that regular physical

activity (e.g. walking) reduces pain and improves function among people with arthritis in the

knees, and Campell et al. (1997) has documented a 58% reduction in falls among older women

who engage in exercise programs.

According to the Physical Activity Guidelines for Americans (2008), being physically

active on a regular basis helps in the prevention of osteoporosis. It also helps to decrease older

adults’ risk of falling and improves their cognitive abilities, improves their mood and helps them

sleep better, increases their chance of enjoying healthier and longer lives, among other benefits.

In agreement with the above, Brach et al. (2004) have also documented that physical activity

improves the overall well-being of older adults. In addition, they have also documented that

moderate lifestyle activities may reduce older adults’ chances of functional limitations.

Moderate intensity walking programs have been shown to attenuate functional fitness

deterioration associated with aging (Morgan et al., 2010). Maintaining functional fitness helps

36

older adults to continue to perform activities of daily living (personal care), and instrumental

activities of daily living (shopping, preparing meals, driving, etc.); all of which will allow them

to continue to live independently and remain in their homes (Rikli & Jones,1999a). As such,

older population should be encouraged to engage in, at least, 20-minute of moderate intensity

physical activity. Engaging in moderate intensity physical activity will help slow the decline of

functional impairment by maintaining lower body strength, a loss of which often lead to falls and

physical frailty (Griffin, 2012.

There is other evidence suggesting additional benefits result from engaging in active

lifestyle activities. The 2008 Physical Activity Guidelines for Americans has documented that

longer and harder exercise could result in even greater benefits. This recommendation supports a

study by Abbott el al (2004), which has shown that, in addition to reducing their prevalence of

diabetes risk and coronary heart disease, older adult men who walk a total of 2 miles/day are 1.8-

folds less likely to develop dementia. A study by Tanasescu et al. (2002) has also been

supported by the 2008 Physical Activity Guidelines for Americans. The study showed that there

is an inverse dose-response relationship between exercise intensity and coronary heart disease

risk reduction. That is, though engaging in moderate exercise such as brisk walking reduces risk,

more intense exercise is associated with greater risk reduction.

In addition to improving cardiac patients’ quality of life, improved fitness helps older

adults to live independent lives (Leon et al., 2005). Engaging in exercise training and activities

such as stairs climbing, walking, doing household chores, cycling, etc. are necessary to improve

cardiac patients’ physical fitness (AHA, 2005).

Intensity of physical activity prescribed to older adults should be dependent on the

physical fitness and the ability of the individual. Low to moderate intensity regular physical

37

activity is good place to start to help to maintain or improve sedentary older adults functional

fitness; where as those who are already active would need more intense physical activity to see

greater results. After reviewing several articles, the authors concluded that there is a divided

view on the volume and capacity as well as the kind of physical activity that is needed to

improve the general fitness of older adults (Heath & Stuart, 2002).

The findings of the current study that only 17.6% (22 of 125) participants met the

ACSM’s recommendation indicate that older adults in this sample do not engage in enough

physical activity to impact their health. With regards to the functional fitness classification, the

findings suggest that even though nearly ½ of the participants were generally classified as

normal, ¼ were classified as below normal indicating that they are at risk of a reduction in their

functional fitness. It is also interesting that ¼ of participants were classified as above normal on

their functional fitness measures, even though they did not meet physical activity

recommendations suggested by the ACSM. Sixty six percent of the participants BMI was

classified as above normal which may have resulted from and/or contributed to their inability to

meet the ACSM’s recommendations and successfully perform the activities in the senior fitness

test.

The main finding of this study was related to time spent in MVPA and how this was

related to functional fitness. Pearson correlation coefficient revealed a statistically strong

positive relationship between the 5 day MVPA and the 6 min walk (F=16.72, p ≤ 0.001),

suggesting that greater time spent in moderate intensity physical activity is related to better

aerobic endurance. Greater aerobic endurance is related the older adults’ ability to walk greater

distances, stair climbing, shop, sightsee while on vacation, etc. (Rikli and Jones, 1999a). There

were also statistically strong relationship between the 5 day MVPA and chair stands (F=14.06, p

38

≤ 0.001) indicating that greater time spent in MVPA is related to greater lower body strength in

older adults. The lower body strength helps older adults to climb stairs, walk and get out of

chair, tub or car as well as reduce their chance of falling (Rikli and Jones, 1990a). Additionally,

the findings showed that statistically significant coefficient (F=13.36, p ≤ 0.001) between MVPA

and up & go indicating that 5 day MVPA is positively related to an older adults’ agility/dynamic

balance. According to Rikli and Jones (1990a), improved agility/dynamic helps with older

adults’ ability to perform quick maneuvers such as getting off a bus in a timely manner, going to

the bathroom or answering the phone or to attend to something in the kitchen.

Consistent with the Pearson’s coefficient correlation, ANOVAs revealed a cut-off point

with regard to time spent in MVPA on the functional fitness measures the 6 min walk, chair

stands, and up & go, and arm curls. For lower body function, the results suggest that 20 minutes

of MVPA, 5 day per week is may be enough to positively impact functional fitness and that

additional time in MVPA may not result in significantly greater performance on these measures.

A threshold of 20 minutes may suggest that engaging in more than 20 min MVPA will not yield

additional statistical gain on the mobility and lower body strength measures of 6 minute walk,

chair stand, and up-and-go. For upper body strength and flexibility, the results suggest that less

than 10 minutes of MVPA is detrimental to performance. However, additional time spent in

MVPA did not result in greater gains in upper body strength.

5.1 Conclusion

ACSM recommends that to maintain health all adults accumulate at least 30 minutes of

MVPA 5 days/wk. However, this study was designed to begin the investigation regarding the

lowest dose possible to maintain functional fitness. Our data suggest that a threshold of 20

39

minutes of MVPA may be enough to impact older women’s lower body functional fitness and

additional time spent in MVPA may not result in significant improvements in lower body

functional fitness. For older women to benefit from regular physical activity and maintain their

upper body strength, our findings show that they need to engage in >10 min of MVPA.

5.2 Future Studies

The results of this study suggest 20 minutes of MVPA 5 days a week is enough to impact

lower body functional fitness. However the ACSM also recommends flexibility, strength, and

balance exercises. Future studies should incorporate flexibility, strength, and balance exercises

to determine a cut-off or dose response of these exercises with respect to their impact on

functional fitness.

40

BIBLIOGRAPHY

41

BIBLIOGRAPHY

Abbott, R. D., White, L. R., Ross, G. W., Masaki, K. H. Curb, J. D. and Petrovitch, H. (2004).

Walking and dementia in physically capable elderly Men. JAMA, 292:1447-1453.

Ainsworth B. E., Haskell, W. L., Leon, A. S., et al. (1993). Compendium of physical activities:

classification of energy costs of human physical activities. Med Sci Sports Exerc, 25:71- 80.

American College of Sports Medicine. (1998). Exercise and physical activity for older adults.

MSSE, 30:992-1008.

American College of Sports Medicine. (1998a). The recommended quantity and quality of

exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in

healthy adults. Med. Sci. Sports. Exerc. 30:975-991.

Aoyagi, Y., Park, H., Watanabe, E., Park, S., & Shephard, R. J. (2009). Habitual physical

activity and physical fitness in older Japanese adults: The Nakanojo study. Gerontology, 523-

531.

Brach, J. S., Simonsick, E. M., Kritchevsky, S., Yaffe, K., & Newman, A. B. (2004). The

association between physical functioning and lifestyle activity and exercise in the health, aging

and body composition study. American Geriatrics Society, 502-509.

Bravata, D., Smith-Spangler, C., Sundaram, V., Gienger, A., Lin, N., Lewis R., et al. (2007).

Using pedometers to increase physical activity and improve health: a systematic review. The

Journal of the American Medical Association, 2296-2304.

Borg, G. A. (1982). Psychophysical bases of perceived exertion. Med. Sci. Sports. Exerc. 14:377-

381.

Buchman, A. S., Boyle, P. A., Yu, L., Shah, R. C., Wilson, R. S., et al. (2012). Total daily

physical activity and the risk of AD and cognitive decline in older adults. Neurology, 78:1323–

1329.

Campell, A. J, Robertson, M. C, Gardner, M. M, Norton, R. N, Tilyard, M. W, Buchner, D. M.

(1997). Randomised controlled trial of a general practice programme of home based exercise to

pr event falls in elderly women. BMJ, 315(7115):10659.

Christensen, H, Korten, A, Jorm, A. F, Henderson, A. S, Scott, R, and Mackinnon, A. J. (1996).

Activity levels and cognitive functioning in an elderly community sample. Age Ageing. 25:72-

80.

42

BIBLIOGRAPHY (Continued)

Caspersen, C. J., Powell, K. E., and Christenson, G. M. (1985). Pysical activity, exercise, and

physical fitness: Definitions and distinctions for health-related research. Public Health Reports.

100(4): 126-131.

Crouter, S. E., Schneider, P. L., Karabulut, M., Bassett, D.R. Jr. (2003). Validity of 10 electronic

pedometers for measuring steps, distance, and energy cost. Med Sci Sports Exerc., 35;1455-60.

Doherty, T. J. Invited review: Aging and sarcopenia. J. Appl. Physiol. 954:1717-1727. Donato, A. J., K. Tench, D. H., Glueck, D. R., Seals, I., Eskurza, and H. Tanaka H. (2003).

Declines in physiological functional capacity with age: a longitudinal study in peak swimming

performance. J. Appl. Physiol. 94:764-769.

DiPietro, L. (2001). Physical activity in aging: changes in patterns and their relation to health and

function. J. Gerontol. A Biol. Sci. Med. Sci. 56:13-22.

Dishman, R. K, Washburn, R. A, Heath, G. W. (2004). Physical Activity Epidemiology, 1st

edition, Human Kinetics.

Drewnowski, A., and W. J. Evans, W. J. (2001). Nutrition, physical activity, and quality of life in

older adults: summary. J. Gerontol. A Biol. Sci. Med. Sci. 56A:89-94.

Emery, C. F, Schein, R. L, Hauck, E. R, and MacIntyre, N. R. (1998). Psychological and

cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive

pulmonary disease. Health Psychol. 1998;17:232-240.

Ferucci, L., Penninx, B. W., Leveille, S. G., Corti, M. C, Pahor, M., Wallace, R. et al. (2000).

Characteristics of nondisabled older persons who perform poorly in objective tests of lower

extremity function. (2000). J Am Geriatr Soc., 48(9):110210.

Franco, O. H., de Laet, C., Peeters, A., Jonker, J., Mackenbach, J., et al. (2005). Effects of

physical activity on life expectancy with cardiovascular disease. Arch Interm Med., 165:2355-

2365.

Fiatarone-Singh, M. A., (2001). Exercise for disease prevention in the geriatric population.

Nutrition in Clinical Care, 4, 296-305.

Haskell, Lee, Pate, Powell, Blair, et al. (2007). Physical activity and public health: Updated

recommendation for adults from the American College of Sports Medicine and the American

Heart Association. Med. Sci. Sports Exerc., 39:8;1423–1434.

43

BIBLIOGRAPHY (Continued)

Haskell, W. L. (1994). Health consequences of physical activity: Understanding and challenges

regarding dose-response. Medicine and Science in Sports and Exercise; 226, 649-660.

Heath, J. M., and Stuart, M. R. (2002). Prescribing exercise for frail elders. JABFP; 15:218-28.

Hunter, G. R., Wetzstein, C. J., McLafferty Jr. C. R., Zuckerman, P. A., Landers, K. A. and

Bamman, M. M. (2001). High-resistance versus variable-resistance training in older adults. Med.

Sci. Sports Exerc. 33:1759-1764.

Kovar, P. A., Allegrante, J. P., MacKenzie, C. R., Peterson, M. G., Gutin, B., and Charlson, M.

E. (1992) Supervised fitness walking in patients with osteoarthritis of the knee. A randomized

controlled trial. Ann Intern Med., 116(7):52934.

Leon, A. S., Franklin, B. A., Casta, F., Balady, G. J., Berra, K. A., et al. (2005). Cardiac

rehabilitation and secondary prevention of coronary heart disease: An American Heart

Association Scientific Statement. Circulation. 2005; 111: 369-376.

Miotto, J. M., Chodzko-Zajko, W. J., Reich, J. L., and Supler, M. M. (1999). Reliability and

validity of the Fullerton Functional Fitness Test: an independent replication study. J. Aging

Phys. Activ. 7:339-353.

Morgan, A. L., Rogers, N. L., Takeshima, N., Amini, S., & Ofei-Dodoo, S. (2011). Impact of

moderate intensity physical activity on the functional fitness of older women. Journal of

American College of Sport Medicine.

Morgan, A. L., Tabor, D. A., & Snyder, L., (2010). Walking toward a new me: The impact of

prescribed walking 10,000 steps/day on physical and psychological well-being. Journal of

Physical Activity and Health, 2010; 7: 299-307.

Moreland, J., Richardson, J., Chan, D. H., O’Neill, J., Bellissimo, A., Grum, R. M., and Shanks,

L. (2003). Evidence-based guidelines for the secondary prevention of falls in older adults.

Gerontology 49:93-116.

Nagasak, I. H., Itoh, H., & Furuna, T. (1995). A physical fitness model of older adults. Aging

Clinical and Experimental Research, 392–397.

Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, P. W., Judge, J. O., King, A. C., et al. (2007).

Physical activity and public health in older adults: recommendation from the American College

of Sports Medicine and the American Heart Association. Medicine and Science in Sport and

Exercise, 1435-1445.

Purath, J., W., Buchholz, S., & L.Kark, D. (2009). Physical fitness assessment of older adults in

the primary care setting. Journal of the American Academy of Nurse Practitioners, 101 - 107.

44

BIBLIOGRAPHY (Continued)

Rennie, K. L., Hemingway, H., Kumari, M., Malik, M., and Marmot, M. (2003). Effects of

moderate and vigorous physical activity on heart rate variability in British Study of civil

servants. Am J Epidemiol, 158:135-143.

Rikli, R., & Jones, C. J., (1999a). Development and validation of a functional fitness test for

community-residing older adults. J. Aging Phys. 7:129-161.

Rogers, M. E., Sherwood, H. S., Rogers, N. L and Bohlken, R. M. (2002). Effects of dumbbell

and elastic band training on physical function in older inner-city African American women.

Women & Health 36:4, 33-41.

Rogers, M. A, and W. J. Evans, W. J. (1993). Changes in skeletal muscle with aging: effects of

exercise training. Exerc. Sports Sci. Rev. 21:65-102.

Rogers, M. E., Rogers, N. L., Takeshima, N., and Islam, M. M. (2003). Methods to evaluate and

improve the physical parameters associated with fall risk in older adults. Prev. Med. 36:255-264.

Rowe, D. A., Kemble, C. D., & Robinson, T. S. (2007). Daily walking in older adults: day-to-

day variability and criterion-referenced validity of total daily step counts. Journal of Physical

Activity and Health, 434-446.

Simpson, M. E., Serdula, M., Galuska D. A., et al. (2003). Walking trends among U.S. adults:

the Behavioral Risk Factor Surveillance System, 1987–2000. Am J Prev Med, 25:95–100.

Takeshima, N., Tanaka, K., Kobayashi, F., Sumi, K., Watanabe, T., and Kato, T. (1993).Effects

of aerobic exercise conditioning at intensities corresponding to lactate threshold in the elderly.

Eur. J. Appl. Physiol. 67:138-143.

Task force of the European Society of Cardiology and the North American of Pacing and

Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation

and clinical use. Circulation1996; 93:1043-65.

Taylor, H. L, Jacobs, D. R. Jr., Schucker B, et al. (1978). A questionnaire for the assessment of

leisure time physical activities. J Chronic Dis, 31:741-55.

Tanasescu, M., Leitzmann, M. F., Rimm, E. B., Willett, W. C., Stampfer, M. J., and Hu, F. B.

(2002). Exercise type and intensity in relation to coronary heart disease in men. JAMA, 288:

1994-2000.

Toraman, N. F., Erman, A., and Agyar, E. (2004). Effects of multicomponent training on

functional fitness in older adults. J. Aging Phys. Activ. 12:538-553.

45

BIBLIOGRAPHY (Continued)

Tudor-Locke, C., & Bassett Jr., D. (2004). How many steps/day are enough? Preliminary

pedometer indices for public health. Sports Medicine, 1-8.

Tudor-Locke, C., Hart, T. L., & Washington, T. L. (2009). Expected values for pedometer-

determined physical activity in older population . International Journal of Behavioral Nutrition

and Physical Activity.

U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for

Americans. 2008.

U.S. Department of Health and Human Services. Promoting active lifestyles among older adults.

2001.

United Nations. (2003). World population prospects: The 2002 revision. United Nations

Population Division.

Voloshin, A. (1988). Shock absorption during running and walking. J. Am. Podiatr. Med. Assoc.

78:295-299.

Williams, D. M., Matthews, C., Rutt, C., Napolitano, M. A., & Marcus, B. H. (2008).

Interventions to increase walking behavior. Med Sci Sports Exerc., 40(7 Suppl): S567– S573.

Woolf, K., Reese, C., Mason, M., Beaird, L., Tudor-Locke, C., & Vaughan, L. (2009). Physical

activity is associated with risk factors for chronic disease across adult women's life. Journal of

the American Dietetic Association, 248-259.

Yaffe, K., Barnes D., Nevitt M., Lui L., and Covinsky K. (2001). A prospective study of

physical activity and cognitive decline in elderly women. Arch Intern Med. 161:1703-1708.

Yamauchi, T., Islam, M. M., Koizumi D., Rogers, M. E., Rogers, N. L., & Takeshima, N. (2005).

Effect of home-based well-rounded exercise in community-dwelling older adults. Journal of

Sport Science and Medicine, 4, 563- 571.

46

APPENDICES

47

APPENDIX A

CONSENT FORM

Accelerometery-Determined Physical Activity and Functional Fitness in Older Adults

You are invited to participate in a study to examine physical fitness and activity levels. We hope

to identify relationships between daily physical activity and strength, balance, flexibility,

mobility, and cardiovascular fitness in older individuals. Knowledge gained from this project

will also assist exercise and medical professionals in prescribing activity and in helping older

individuals maintain their independence. We would like you to take part in this study. You were

selected as a possible participant in this study because your age is within the range in which we

are interested. We will recruit approximately 300 people to participate in this project.

If you decide to participate, you will be asked to perform a series of assessments. These

assessments are designed to measure your ability to maintain your balance and to measure your

functional ability. The assessments will be done at the site you were recruited from.

During the assessments we will ask you to stand on a balance platform and on a piece of foam

while your balance is assessed. You will also perform a timed test where you will be asked to

stand from a chair, walk 8 feet, and return to the chair. Your lower body flexibility will be

assessed while sitting in a chair and reaching toward your toes and strength will be assessed

while rising from a chair and sitting down for 30 seconds. Your walking ability will be assessed

by having you walk around a 50-yard perimeter for twelve minutes. Your upper body strength

will be assessed while lifting a dumbbell (5 pounds for women, 8 pounds for men) for 30

seconds and flexibility by placing your arms behind your back. To measure your typical daily

activity, you will be given a “locked” accelerometer, a small device attached at your waist, to

wear for 2 weeks. We will explain when and where to wear the accelerometer. Two weeks after

the assessments, we will meet with you at your recruitment site to “unlock” your accelerometer

and record step counts for that week.

Potential Risk

Physical movement rarely causes problems in healthy adults. However, if they suffer from

hidden heart disease, an exercise test could cause chest pain, dizziness, or bouts of irregular heart

rhythms. Also, there is always a slight risk of a heart attack occurring during the exercise tests in

persons with preexisting heart disease. You will be asked about any type of disease that you may

have.

48

APPENDIX A (continued)

Muscle soreness could also occur following any of these physical activities. You will receive

proper instruction for all activities. The supervisors of the program have extensive experience

leading activities like the ones you will perform.

Potential Benefits

Many studies have found that poor functional fitness is a major limitation in gaining and

maintaining physical independence. You will gain an understanding of your own physical

abilities and an appreciation for the effects of physical activity on these parameters. In general,

this study will improve the knowledge concerning the potential for improved functional fitness in

older individuals, enhancing the ability to help people live independently for longer periods of

time.

If you take part, your results will be combined with other participants so it will not be possible to

identify your responses in a published report; your name will not be directly associated with any

of the results.

You have been informed and you understand that Wichita State University does not provide

medical treatment or other forms of reimbursement to persons injured as a result of or in

connection with participation in research activities conducted by Wichita State University or its

faculty. In an event where you believe that you have been injured as a result of participating in

the research covered by this consent form, you should contact the Office of Research

Administration, Wichita State University at 316-978-3285.

If you have any questions concerning this study, you may contact Dr. Rogers at work (316-978-

6684). You may also contact the Office of Research Administration at 316-978-3285.

YOU ARE MAKING A DECISION WHETHER OR NOT YOU WILL PARTICIPATE IN

THIS STUDY. YOU SHOULD NOT SIGN UNTIL YOU UNDERSTAND ALL THE

INFORMATION PRESENTED IN THE PREVIOUS PAGES AND UNTIL ALL YOUR

QUESTIONS ABOUT THE RESEARCH HAVE BEEN ANSWERED TO YOUR

SATISFACTION. YOUR SIGNATURE INDICATES THAT YOU HAVE DECIDED TO

PARTICIPATE IN THIS STUDY.

49

APPENDIX A (continued)

You will be offered a copy of this letter to keep.

I agree to take part in this project. I know what I will have to do and that I can stop at any time.

______________________________ _______________

Signature of Participant Date

______________________________

Name Printed

______________________________ _______________

Nicole L. Rogers, PhD Date

Principal Investigator

50

APPENDIX B

EXERCISE AND SCREENING FOR YOU FORM

51

APPENDIX C

MEDICAL CLEARANCE FORM

A Community-Based Multi-Component Physical Activity Program for Older Adults

MEDICAL CLEARANCE OF PERSONAL PHYSICIAN

Your patient, __________________________, has expressed an interest in participating in a Community-

Based Walking Program, offered through the Department of Public Health Sciences Aging Studies Program

and Department of Human Performance Studies at Wichita State University and Health Strategies.

We would appreciate your medical opinion and recommendations concerning this individual’s participation

in exercise. If you feel that this individual might benefit from participation in the program, we would greatly

appreciate your endorsement of his/her participation.

Assessments: The program participants are asked to complete a series of functional fitness assessments

as well as a moderate intensity walk. This are completed to identify weaknesses in physical parameters

associated with activities of daily living and to more effectively prescribe appropriate exercise.

Physical Parameters Assessments Approval

Cardiovascular 12 minute walk yes ___ no___

Muscular Strength / Endurance 30 second chair stand yes___ no___

30 second arm curl yes___ no___

Flexibility Chair sit-and-reach

yes___ no___

Back scratch yes___ no___

Balance & Gait 8 foot up-and-go yes___ no___

Computerized Postural Sway yes___ no___

Computerized Limits of Stability yes___ no___

Moderate Intensity Walk 15 minute walk at moderate intensity yes___ no___

*wearing heart rate monitor

Submaximal exercise test YMCA Bicycle Test yes___ no___

52

APPENDICE C (continued)

Please list any modifications/comments for testing and the walking program:

____________________________________________________________________________________

Please indicate by your signature below that your patient is medically cleared to participate in the

specific portions of testing and training as described. Please call Dr. Rogers if you have any question

concerning the program at (316) 978-6684.

________________________ __________________________ _____________

Signature of Physician Print Name of Physician Date

Physician phone #: ( ____ ) _____ - ______

Please return this form by FAX or Postal Mail to:

Nicole L. Rogers, PhD

Fax: 316.978.3072

Assistant Professor, Aging Studies

Program Director, Aging Studies

Department of Public Health Sciences

College of Health Professions

Wichita State University

1845 Fairmount - Campus Box 43

Wichita, Kansas 67260

Phone: 316.978.6684

Email: nicole.rogers@wichita.edu

53

APPENDIX D Participant ID ________________________

Demographic Questionnaire

1. What is your age in years?

______ years

2. What is your ethnic background?

White/Caucasian

Black/African American

Hispanic or Latino

American Indian/Alaska Native/Pacific Islander

Asian or Asian/American

3. What is your marital status?

Married/Or Live With Significant Other

Single/Live By Self

Divorced/widowed/live by self

4. What is the highest grade you have completed in school?

___________ (record grade number)

5. What is the title of your current job/position?

______________________________________

54

APPENDIX D (Continued)

6. List the “prescription” medications that you currently take: (by exact name or by type)

Type of medication For what condition

______________________________ ______________________________

______________________________ ______________________________

______________________________ ______________________________

______________________________ ______________________________

______________________________ ______________________________

7. Smoking Status

Do you currently smoke cigarettes? No ____ Yes ____

If yes, number of cigarettes smoked on an average day ______

If no, have you ever smoked? No ____ Yes ____

For how many years? _______

How many cigarettes did you smoke on an average day _______

How many years since you stopped? ________

8. How many drinks of an alcoholic beverage do you have in a typical week?

_________ Bottles or cans of beer

_________ Glasses of wine

_________ Wine coolers or other malt beverages

_________ Mixed drinks or shots of liquor